Healthcare Provider Details

I. General information

NPI: 1447241468
Provider Name (Legal Business Name): LAURA JANE GRAYBEAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA KEATING M.D

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W NEVILLE ST SUITE 200
BECKLEY WV
25801-4360
US

IV. Provider business mailing address

921 W NEVILLE ST SUITE 200
BECKLEY WV
25801-4360
US

V. Phone/Fax

Practice location:
  • Phone: 304-254-8346
  • Fax: 304-254-8348
Mailing address:
  • Phone: 304-254-8346
  • Fax: 304-254-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20972
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number20972
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: